9.0 DATA SOURCES AND LIMITATIONS

MENTAL HEALTH PROFILE 2018

Community Mental Health Survey (2017)

Ipsos Public Affairs conducted the Community Mental Health Survey on behalf of Lambton Public Health. They used a telephone methodology with dual frame design, starting first with cell phone sample to better reach younger residents, and then following with landline sample. This resulted in a final sample of 66% cell phones and 34% landlines. The survey was 16 minutes in length.

A total of 802 residents of Lambton County were surveyed between Tuesday, June 20 and Monday, July 10, 2017. A demographic profile of participants can be found in the Community Mental Health Survey and Qualitative Research: Final Report.

Many of the questions in the survey were drawn from, and in some cases adapted, from the Canadian Community Health Survey (CCH-MH), Mental Health Continuum Short Form (MHC-SF), Mental Health Literacy Scale (MHLS), Connor-Davidson Resilience Scale, and Ipsos’ Annual Canadian Mental Health Check-up.

In a voluntary study, a non-response bias may be present: people who are in poor mental health may be less likely to want to participate in the survey and therefore be underrepresented. It is also important to note that in any telephone survey with an interviewer, there may be a social desirability bias in which respondents tend to provide answers that could be considered socially desirable, for example, they may wish to portray themselves or their communities in a more positive light.

Mental Health Online Bulletin Board (2018)

 Ipsos Public Affairs gathered qualitative information via an online bulletin board. The study targeted two groups: 1) individuals who rated their mental health as good, fair or poor who were recruited through established market and social research panels and 2) individuals who accessed mental health services in Lambton for themselves or their children who were recruited by local service providers.

A total of 39 participants took part in the study between January 22nd and 23rd, 2018. This included 27 females and 11 males. A wide range of ages was represented (18-34: 11; 35-44: 9; 45-64: 12; 65 and older: 6).

Participants were asked to answer a series of close-ended and open-ended questions and the bulletin board was moderated by an Ipsos researcher. The value of qualitative research is that it allows for the in-depth exploration of factors that shape attitudes and behaviours on certain issues. The intention is not to produce results that are statistically representative of the population at large.  All quotations from the online bulletin board are attributed to either a “Community Member” or a “Parent”, as appropriate.

Emergency Department Visits and Hospitalizations

Emergency department visits were identified from the National Ambulatory Care Reporting System (NACRS) using the International Classification of Diseases, Tenth Revision, with Canadian enhancement (ICD-10-CA). NACRS was accessed via IntelliHealth Ontario provided by the Ontario Ministry of Health and Long-Term Care.

Hospitalizations were identified from the Discharge Abstract Database (DAD), which uses ICD-10-CA coding for primary diagnosis field, and the Ontario Mental Health Reporting System (OMHRS), which uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth Edition (DSM-IV and DSM-5). Provisional diagnoses were used when the primary diagnosis at discharge was not complete. The DAD captures discharges from regular hospital beds, while OMHRS captures discharges from designated ‘adult’ mental health beds. Note that while the beds are designated for adults, children and youth may be admitted to these beds depending on the hospital practices.

Two recent ICES reports were used to determine the correct codes for inclusion: 1) The Mental Health of Children and Youth in Ontario: 2017 Scorecard (MHASEF Research Team 2017a) and 2) Temporal Trends in Mental Health Service Utilization across Outpatient and Acute Care Sectors: A Population-Based Study from 2006 to 2014 (Chiu et al. 2018).

DSM-5 was implemented starting in the 2016/17 fiscal year, so was not included in the above reports. Due to the use of both DSM-IV and DSM-V in this report, obsessive-compulsive disorder (OCD) was excluded from anxiety disorders for all years to be consistent with the new DSM-5 categorization. Whereas OCD previously fell under the “Anxiety Disorder” category, it now falls under “Obsessive-Compulsive and Related Disorders”.

The only other difference between this report and reports cited above was that we included all deliberate self-harm visits, while the authors of the studies above only included self-harm visits when there was not a primary mental health diagnosis. We felt that it was important to capture all self-harm related visits, but this means that some of those counted as a self-harm visit may also be counted under one of the other diagnostic groups.

ICD-10 Codes used for ED visits (NACRS) and hospitalizations (DAD):

All mental health and addictions: F04-F99 in primary field OR X60-X84, Y10-Y19, Y28 in secondary position when there is no F04-F99 in the primary problem field.

Substance-related disorders: F55, F10-F19.

Schizophrenia: F20 (excluding F20.4), F22-F25, F28, F29, F53.1

Mood disorders: F30-F34, F38, F39, F53.0

Anxiety disorders: F40, F41, F43, F48.8, F48.9

Deliberate self-harm: Secondary diagnoses fields: X60-X84, Y10-Y19, Y28

DSM-IV/5 Codes or Provisional Diagnosis for hospitalizations (OMHRS):

All mental health and addictions: Any diagnosis (excluding 290.x or 294.x, which are dementia codes)

Substance-related disorders: 291.x (all excluding 291.82), 292.x (all excluding 292.85), 303.x, 304.x, 305.x OR provisional diagnosis 4

Schizophrenia: 295.x, 297.x, 298.x OR provisional diagnosis 5

Mood disorders: 296.x, 300.4x, 301.13 OR provisional diagnosis 6

Anxiety disorders: 300.0x, 300.2x, 308.3x, 309.0x, 309.24, 309.28, 309.3x, 309.4x, 309.8x, 309.9x OR provisional diagnosis 7, 15

Deliberate self-harm: Not applicable

Office of the Chief Coroner for Ontario

A custom data request was made for suicide related deaths in Lambton and Ontario. Data were provided for all ages and for those less than 19 years of age. (Date: November 9, 2017).

Note that the number of suicide deaths may be lower than expected based on anecdotal evidence and media reports. The coroner determines the manner of death. In order to classify a death as a suicide, coroners follow rules laid out by Ontario’s courts, which they refer to as the Beckon test. If the evidence doesn’t clearly point to suicide, the manner of death is deemed undetermined.

School Climate Survey

The Lambton-Kent District School Board provided Lambton Public Health with the results of the LKDSB Speak Up! Student Survey (Smith, M. 2014). This was an online survey conducted with students in grades 7 to 12 between November 25th and December 6th, 2013.

The survey was voluntary and of the 12,761 eligible students, 8,090 responses were received, for an overall response rate of 63%. Results are presented for Lambton and Chatham Kent students combined, as they were not separated within the report.

Canadian Mental Health Association, Lambton-Kent Branch

Client data were provided for the Sarnia Branch office for the dates May 1, 2017 to March 28, 2018. The full year is not included, as a new data system was implemented on May 1st.

St. Clair Child and Youth Services

Client data were provided for the fiscal year April 1, 2016 to March 31st, 2017.

Top presenting issues for active clients at the point of first contact includes the following core services: brief services, counselling and therapy, crisis services, intensive services, specialized consultation/ assessment services; Youth Justice programs; and Dual Diagnosis programs. A client could have more than one presenting issue.

Stakeholder Activity Scan and Qualitative Data Collection

Local stakeholders were asked to complete a template describing current health promotion initiatives in their organization. This was not an exhaustive scan of all relevant agencies, but rather a limited snapshot to provide local examples.

Stakeholders were also asked to provide qualitative responses to questions related to why mental health is important, how stigma impacts people they work with, components of their work that support mental health and what they would like to see more of to support mental health in Lambton. All quotations from these stakeholder surveys are attributed to a “Mental Health Care Worker”.

Other Notes

Some of the quotations from survey respondents, online bulletin board participants and stakeholder surveys have been edited for grammar or clarity. We attempted to make as few of these edits as possible and to stay true to the meaning of any comment that was submitted.

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REFERENCES AND RESOURCES